Musc - Shoulder Flashcards
Risk factors for rotator cuff tear
○ Age ○ Overuse (e.g. overhead movement) ○ Trauma ○ Obesity Diabetes
3 Mechanisms of rotator cuff tears
○ Acute tears on a background of pre-existing degeneration (with minimal force required)
○ Acute tears in healthy young patients (requires a lot of force and is associated with other injuries
○ Chronic tears due to microtrauma over time (overuse in increasing age)
Classification of rotator cuff tears
§ Partial thickness § Full thickness □ Small (<1cm) □ Medium (1-3cm) □ Large (3-5cm) □ Massive (>5cm or involving multiple tendons)
Presentation/tests for rotator cuff tears
Painful arc
Limitation of shoulder abduction
Supraspinatus
Jobe’s test - empty can
Neer test
Infraspinatus/teres minor
External rotation against resistance
Subscapularis
Lift off test
Mx of rotator cuff tears
○ Conservative
§ For people not troubled by pain or loss of function, analgesia and physio
○ Medical
§ Steroid injections may be beneficial
○ Surgical
§ Large or massive tears (greater than 2cm) should be repaired surgically (arthroscopic or open)
Causes of subacromial impingement syndrome
○ Intrinsic
§ Subacromial bursitis
§ Supraspinatus tendinitis (AKA calcific tendinitis)
§ Result of shoulder overuse leading to microtrauma and inflammation
§ Rotator cuff tendinosis (degenerative changes)
○ Extrinsic (extrinsic compression of rotator cuff tendons) § Scapular muscular dysfunction § Glenohumeral instability § Anatomical variations
Presentation/tests for subacromial impingement
Painful arc
Weakness and stiffness of shoulder abduction
Neer test
Hawkins test
How to distinguish subacromial impingement from adhesive capsulitis/rotator cuff tear
In subacromial impingement it is the pain that causes the stiffness - stiffness subsides once pain is relieved
Weakness and stiffness persist even without pain in rotator cuff tear and adhesive capsulitis
Investigations for rotator cuff tear/subacromial impingement
XR shoulder (AP and Lat) MRI
Mx of subacromial impingement
Inc. 3 surgical options
Conservative
- Analgesia, physiotherapy
Medical
- Steroid injections
Surgery
- Subcromial bursa removal
- Rotator cuff tendon repair
- Acromioplasty (increases subacromial space)
Most common location for shoulder fracture
Proximal humerus
Shoulder fracture classification system
Neer Classification - number of fragments (2, 3, 4)
Management of shoulder fracture
Conservative
- Appropriate most of the time, apply polysling to allow arm to hang, with early mobilisation after 2-4 weeks
Surgical
- For displaced, open or vascularly compromised fractures (ORIF)
IM nail if surgical neck fracture or if there is an associated humeral shaft fracture
Types of shoulder dislocation and causes
Anterior: External forces, trauma
Posterior: Seizures, electrocution
Associated injuries from anterior shoulder dislocation
○ Hill-Sachs
§ Dent in the humeral head due to impaction on the glenoid
○ Bankart/Bony Bankart
§ Tear of the labrum of the glenoid with the dislocation
○ Axillary nerve neuropraxia
○ Rotator cuff injuries
- Humeral fracture
